PRELIMINARY APPLICATION

YOUTH EXCHANGE AND STUDY PROGRAM

Attach a photo of
you smiling here.

Spend a year with a family in the USA! The Kennedy Lugar YES Program is available to Moroccan students
aged between 15 and 17 years old, who have existing good English language skills. Please complete the following
th
application in block letters and submit it on or before Thursday, November 5 , 2015.
All information must be included for your application to be considered.
Student Name __________________
Family name

_______________
First/Given Name

Where were you born? ________________________________________

High School:

___________________________________

Academy:

____________________________________

Student Address:
Contacts:

__________________________________________________________________

______________/________________/________________/__________________________
Landline
Mobile Phone
E-mail

Student Birth Date

Day / Month / Year
st
st
(Applicant must have been born between August 1 , 1999 and August 1 , 2001) ___ /____ /____

Current year in high school: Tronc commun___________

1re du Bac____________

Last Years Grade Averages:

English ______________

English Teacher:

Moyenne Gnrale ______

English Teachers

________________________________________
Name
School/Institution
________________________________________

Recommendation:

________________________________________

Signature:

________________________________________

Parental consent to participate:__________________________________

Fathers name:

______________

Fathers signature: ______________

Mothers name:

______________

Mothers signature: ______________

Please provide us with transcripts from the last three (3) years
for your application to be considered.
This is the first in a series of steps for application to the Kennedy-Lugar
Youth Exchange and Study program.
Successful applicants will be contacted for language testing and interview.

Rabat: 35, rue Oukaimeden, Agdal

Casa: Angle Avenue Massira Khadra
et Ibn Zarrara, 1er tage, Marif
Tlphone:
Rabat: 05-37-67-50-75/81/82
Casa: 05-22-25-93-93
Email:
MoroccoYES@amideast.org